Newborn hearing screening: An outpatient model
The purpose of this study was to assess the feasibility of implementing an outpatient model of a newborn hearing screening program with a particular focus on determining how compliance with the follow-up appointment related to specific socio-economic and demographic factors associated with the mother.
Mothers who delivered their babies in public hospitals in Recife, northeast Brazil, were invited to participate in a two-step program. In Step 1 they were interviewed with regard to specific socio-economic and demographic factors, and then scheduled for a hearing screening test for their baby 1 month after discharge. In Step 2, the baby's hearing was screened using transient otoacoustic emissions.
A total of 1035 mothers consented to participate in Step 1, but only 149 returned to participate in Step 2 (14.3%). Analysis of the socio-economic and demographic factors indicated that mothers who did not comply with the scheduled newborn hearing screening (NHS) test generally had less than a high school education and came from primarily lower income families who lived in rural areas outside of Recife.
The results of this study highlight some socio-economic and demographic factors of the population of northeast Brazil that contribute to a low compliance rate for an outpatient model of a newborn hearing screening program. Possible solutions to the low compliance rate are considered.
Available from: Bolajoko Olusanya
- "While no defi nitive pattern could be observed between the referral rates and ambient noise levels across all sites, the high false-positive rates associated with TEOAE in this study would underscore the need for a second-stage screening with AABR to bring the overall referral rates within the recommended limit of 4% (JCIH, 2007). This is without prejudice to the possible reduction that could be achieved through a second-stage screening with the same technology on a return visit after several days, as has been reported with TEOAE in some studies from other developing countries (Tanon-Anoh et al, 2010; Griz et al, 2009; Tasci et al, 2009; Bansal et al, 2008). However, it was unlikely that the reduction achieved from the combined TEOAE/AABR in this population was possible with a TEOAE-only protocol given the age profi le in "
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ABSTRACT: Considering that current newborn/infant hearing screening (NHS) instruments were designed primarily for use in developed countries, this study set out to ascertain the potential effects of higher ambient noise levels on transient-evoked otoacoustic emissions (TEOAE) in sub-Saharan Africa. Data was drawn from two hospital-based and community-based NHS programs in Lagos, Nigeria, with a total screened population of 11 893 infants. Two automated TEOAE screening devices-Echo-Screen and ECHOCHECK-were available for this study. Ambient noise levels ranged from 61.0-90.5 dBA in the hospital wards and 55.6-82.5 dBA in the community health centers. One TEOAE model could not be activated at the prevailing noise levels. No significant pattern was observed in average noise levels and overall TEOAE referrals across all screening sites. However, the false-positive rates ranged from 1.4-13.8%. This study suggests that valid TEOAE screening is attainable in the Negroid race in settings with ambient noise levels up to 68 dBA but the associated high false-positive rates may necessitate additional screening with auditory brainstem response to achieve acceptable overall referral rates for timely diagnostic evaluation.
Available from: scielo.br
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ABSTRACT: Neonatal hearing screening programs have been developed worldwide. Since 2002, the newborns from the Center for Integral Assistance to Women's Health at UNICAMP have been referred to hearing screening at the Center for Studies and Research on Rehabilitation "Prof. Dr. Gabriel Porto". Nevertheless, not all newborns come to the screening and others drop out before the procedures are completed. The goal of this research was to characterize the newborns' adherence rates to the Neonatal Hearing Screening Program. A retrospective investigation was carried out, collecting data on the records of all cases screened from February to November of 2007. A total of 2107 infants were referred to hearing screening and 1310 actually came. Among those who failed the test (92 infants), 73 returned for the retest with the use of BAEP. The adherence rate in the first stage of the screening was 62.17% and, in the second, 79.34%. These rates are bellow the ones recommended by the JCIH as well as bellow those reached by hearing screening programs of some developed countries. However, they are similar to other Brazilian experiences of neonatal hearing screening programs. A close follow up of the families of those infants who failed the first stage of the screening, as well as the orientation given to them about early detection of hearing loss and its consequences, may have contributed to the increase in the adherence rate in the second stage of the screening.
Available from: De Wet Swanepoel
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ABSTRACT: Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape.
A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants that were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized. The target disorder was uni- or bilateral hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement.
Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0-14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion.
The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel.
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